Short-Term Effects of a Gain-Focused Reappraisal Intervention for Dementia Caregivers: A Double-Blind Cluster-Randomized Controlled Trial

Cheng, Sheung‐Tak; Fung, Helene H.; Chan, Wai Chi; Lam, Linda Chiu Wa

doi:10.1016/j.jagp.2016.04.012

Cited by 58 publications

(85 citation statements)

References 33 publications

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“…For that reason, intentional interventions by professionals are necessary to improve positive appraisal among caregivers. Previous studies reported that interventions focusing on positive appraisal were successful in improving the same as well as in reducing caregiver burden . However, despite the existence of many such interventions with promising results, they have not yet been widely implemented in clinical practice .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported that interventions focusing on positive appraisal were successful in improving the same as well as in reducing caregiver burden. 7,38 However, despite the existence of many such interventions with promising results, they have not yet been widely implemented in clinical practice. 39 As such, we thought it also necessary to consider providing brief interventions that focus on caregiver burden and positive appraisal to family caregivers, as such assistance might be more feasible for clinical application.…”

Section: Discussionmentioning

confidence: 99%

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Changes in caregiving appraisal among family caregivers of persons with dementia: A longitudinal study over 12 months

2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in caregiving appraisal among family caregivers of persons with dementia: A longitudinal study over 12 months

2018

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“…This also implies more attention to outcomes other than burden and depression, especially positive outcomes such as mastery and QoL. Other positive outcomes such as positive aspects of caregiving [84,85] also deserve more attention given their relevance to caregivers' functioning.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

Cheng

Zhang

2020

BMC Geriatr

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Background: Many reviews with conflicting findings on dementia caregiver interventions have been published. A meta-review was conducted to synthesize the findings of systematic reviews and meta-analyses. Methods: MEDLINE, PsycINFO, CINAHL and Cochrane Library were searched to identify reviews published during 2006-2018. Results: Sixty reviews covering > 500 intervention studies were selected and appraised with Assessment of Multiple Systematic Reviews (AMSTAR) II. The great majority of studies were of low quality according to AMSTAR II, but quality factors appeared unrelated to the conclusions obtained. Depression was most modifiable, with effects found across a spectrum of interventions (psychoeducation, counseling/psychotherapy, occupational therapy, mindfulnessbased interventions, multicomponent interventions, etc.). Evidence of intervention effect was also found for quality of life (psychoeducation), mastery (psychoeducation, occupational therapy and multicomponent interventions) and communication skills (communication training). Null or weak results were found for anxiety, social support and burden. Support groups and respite were generally ineffective. There was no evidence that dyadic programs were better than caregiver-only programs, or that programs delivered individually or in groups would differ in their impacts. The evidence also does not support multicomponent interventions to have broader impacts than single-component programs. Methodological issues in the existing reviews (e.g., selective use of studies to serve different research purposes and inconsistent classification of interventions) were noted and taken into account when interpreting findings. (Continued on next page)Conclusions: This meta-review clarified variations in review methodology and identified a few potent groups of intervention (most notably psychoeducation, psychotherapy, occupational therapy, and multicomponent interventions), although no intervention type had broad effects on caregiver outcomes. We note that improvements are needed in the reporting of intervention studies and in making the classification of interventions more transparent and consistent. We further recommend fewer and larger-scale reviews and more attention to positive outcomes in order to better inform the field. Developing interventions with broader impacts and packaging them to meet caregivers' changing needs in the course of dementia should be a priority for researchers and practitioners.

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“…Thus, besides reflecting on their experiences and coming up with personally relevant benefits, participants were given hypothetical caregiving situations and were asked to come up with as many positive reappraisals as possible. 5,8,9 For example, when discussing particular neuropsychiatric symptoms, scenarios were presented about different fictitious caregivers frustrated by some symptoms and participants would be asked to "help" them by offering alternative appraisals. To consolidate learning during training sessions, caregivers were asked to keep journals of positive appraisals up to three times a week, which were then shared during the next training session.In addition, participants were asked to examine how negative thoughts affect their motivation to provide care and how reappraisal can help sustain the motivation in the long…”

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The Principles and Techniques of Benefit-Finding for Dementia Caregivers: Reply to Gersdorf

Cheng

2018

The American Journal of Geriatric Psychiatry

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Using cognitive reappraisal to promote positive gains is a distinctive feature of the benefit-finding intervention (BFT). However, the intervention would not appeal to caregivers if it burdens them with extra training sessions, on top of a usual psychoeducation program.Furthermore, because the challenging aspects of dementia care (e.g., dealing with neuropsychiatric symptoms and impairments in activities of daily living) 1 provide exactly the context for searching for meanings, 2 positive reappraisal exercises are embedded within related topics when these challenging aspects are discussed, instead of being covered in stand-alone sessions. 3 This is probably more acceptable to caregivers as they come mainly for knowledge and care skills.BFT is often compared to cognitive-behavioral therapy (CBT) 4 because of the common focus on cognitive reappraisal, but in fact it departs from CBT in important ways. Although the role of dysfunctional thoughts is discussed initially in BFT as a way to illustrate the impact of thoughts on behaviors and emotions, the emphasis quickly shifts to reappraisal and discovering positive gains rather than exploring and confronting dysfunctional thoughts. 3,5 As Gersdorf 4 has rightly pointed out, this approach avoids the perception that the caregivers are "being fixed" in a psychotherapeutic context and increases the acceptability of the intervention. Moreover, CBT aims at correcting distorted thinking by realistic appraisal, not positive appraisal, 6 whereas positive reappraisals are the focus of BFT.In BFT, caregivers are asked to use cognitive reappraisal to serve the purpose of finding positive implications for oneself. For example, a spouse caregiver whose wife complains that he is seeing another woman may also treasure the fact that his wife still cares about their marital relationship after so many years. It does not lessen the wife's delusion but may reduce his anger when being accused. More examples can be found in earlier articles. [7][8][9] To help participants see the "benefits of benefit-finding" and to provide models of Page 2 of 7 positive coping, three caregivers (a daughter, a daughter-in-law, and a wife) who had coped well shared their experiences in pre-recorded videos. 3 In order to enhance the likelihood that the participants would resonate with the stories, both difficulties and positive gains were covered in the videos. Hearing it directly from those in the same boat would be more convincing than listening to the trainer alone. We were not able to find male caregivers to record such videos; this is an aspect that can be improved in the future.While the stories in the videos were encouraging, participants needed to build up confidence and competence in using positive reappraisal to reframe their situations on a daily basis. The emphasis is not on realistic thinking here as in CBT, 6 but on the ability to engage in alternative thinking. Even if a caregiver can find an alternative cognition to replace the current one, the ultimate goal of the training would be for the ca...

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Short-Term Effects of a Gain-Focused Reappraisal Intervention for Dementia Caregivers: A Double-Blind Cluster-Randomized Controlled Trial

Cited by 58 publications

References 33 publications

Changes in caregiving appraisal among family caregivers of persons with dementia: A longitudinal study over 12 months

Changes in caregiving appraisal among family caregivers of persons with dementia: A longitudinal study over 12 months

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

The Principles and Techniques of Benefit-Finding for Dementia Caregivers: Reply to Gersdorf

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